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She Landed 30 Feet From Her Shoes

On a beautiful June afternoon, Heather Mosley ran outside to the sight of her daughter lying in their neighborhood street.

Her shoes sat 30 feet from her, in the spot where just seconds before a car had struck her.

From that instant, the Mosley family was in a heart-pounding race to keep Ava alive.

Ava, 5, and her younger sister, Alaina, had gone to a friend’s house to play after attending a carnival earlier in the day, and were on their way home when Ava was hit, just feet from her younger sister.

“She was lying there, and I kind of expected to see her and have her say, ‘Mommy, I hurt my leg.’ She was completely unconscious.”

“She was lying there, and I kind of expected to see her and have her say, ‘Mommy, I hurt my leg.’ She was completely unconscious.”

Fearing the worst

Heather, a nurse, feared the worst as they waited for the ambulance to take them to the Avera Creighton Hospital. There, doctors treated Ava with the use of eEmergency, an Avera service that streams video feeds between rural hospitals and a hub in Sioux Falls, connecting local doctors with emergency physicians in real time. Through eEmergency, Dr. Ronald Morse, a family practice physician who was on call that day, was able to consult with a trauma specialist in Sioux Falls, quickly coordinate an air transfer to the nearest hospital in Sioux City, Iowa, and ensure that a neurologist was at the hospital and ready to treat Ava when she arrived. The situation was complicated by major flooding in the Sioux City area at the time.

Those moments were petrifying for Heather and her husband Shawn. “I just thought, ‘I'm not going to be able to take my daughter home.’ You know, ‘Is she going to make it out of here alive?’ I really didn't know what to think, but every horrible image you could think of was going through my head.”

Ava was in the Creighton emergency room for a short 20 minutes before her transfer, but those minutes were critical to ensure her vital signs stayed strong.

Swift care

Upon Ava’s arrival to the Creighton ER, extra staff was on hand and the eEmergency team had already been called and was prepared for her arrival.

“She wasn’t talking at all. She was totally unconscious. We always go by the Glasgow Coma Scale, and it was half of what it should be. This was a major concern, because it usually signals a poor outcome.”

“When you see a little one so motionless, that’s disheartening right there,” Dr. Morse said. “She wasn’t talking at all. She was totally unconscious. We always go by the Glasgow Coma Scale, and it was half of what it should be. This was a major concern, because it usually signals a poor outcome.”

In consultation with eEmergency, Dr. Morse ordered placement of an IV. Ava’s young age necessitated that staff do it a way they had not done previously. A breathing tube also was placed, and the team started testing her vitals and looking for other serious injuries.

Thankfully, Ava’s vitals were stable and she had no major broken bones or open wounds – all good signs. But Dr. Morse knew Ava had a serious head wound, making her quick transfer to a larger hospital essential to ensure that any swelling was relieved as soon as possible.

The eEmergency connection

Dr. Morse said Ava’s care exemplifies how important eEmergency can be in a small community that doesn’t often come across serious emergencies such as a car accident, particularly when it comes to coordination of care. The use of eEmergency allowed Dr. Morse and his team to focus on Ava.

eEmergency connects 85 rural locations to a hub in Sioux Falls with the push of a button, linking the expertise of local doctors with the knowledge of specialists who are sometimes hundreds of miles away. This partnership allows for better outcomes for patients with trauma, stroke or other critical care issues.

“If it wasn't for Avera eEmergency, we wouldn't have our Ava today,” Dr. Morse said. “Or if we did, she wouldn't be in near as good of condition and shape as she is now.”

Heather said she knew her daughter would be in good hands at Avera Creighton. But knowing that eEmergency was being used also was a comfort.

“It was very reassuring for me to know that there was a specialist on the other end who sees this all the time, and who knows inside and out what to do, and that there's a nurse there to help my fellow nurses so they didn't have to take time away from Ava to go make a phone call to arrange a transfer or to get an accepting physician or something to that effect,” she said. “I don't even want to know what could have happened if we wouldn't have had that connectedness.”

‘A typical first grader’

Ava spent 109 days in the hospital, first in Sioux City then in Omaha, Neb., including time at the Madonna Rehabilitation Hospital, which specializes in brain injuries.

The experience changed their lives and priorities.

“I look at the pictures and it makes me think of how much worse it could have been, all the things that did go right, and the wonderful people who were taking care of us and supporting us the whole time,” Heather said.

Following the accident, physicians and family thought Ava might be blind, but they later realized that she suffers from perception issues.

Today, Ava, 8, is in the first grade. She can write her name and read, and loves to play with her cat.

“She's come an amazingly long way,” Heather said. “She's a typical first grader. She tests where all the other first graders do. If you meet her on the street, you'd probably never know there was anything wrong, that anything happened.”